Medicaid and Schools Tara Larson, Assistant Director DMA October 4, 2006

The Current Medicaid Environment NC serves 1.5 million Medicaid recipients during FY % of NC population is eligible for Medicaid NC serves 1.5 million Medicaid recipients during FY % of NC population is eligible for Medicaid 19% birth to 4 and 37% ages % birth to 4 and 37% ages Billion Dollars 8 Billion Dollars 55,000 different providers, including LEAs 55,000 different providers, including LEAs

DMA and LEAs Starts and Stops Starts and Stops Moving Forward Moving Forward –Formation of an advisory group –Membership Representation of LEAs Representation of LEAs DPI DPI DMA DMA –Mutual agreement of outcomes and priorities –Avenue for communication, hot issues, CMS news

Provide Medicaid reimbursable services in schools to the extent possible. Provide Medicaid reimbursable services in schools to the extent possible. Recognize schools and staff as providers of service. Recognize schools and staff as providers of service. Establish practices and procedures that utilize existing school documentation and practices to the extent possible while maintaining compliance with CMS and NC Medicaid requirements. Establish practices and procedures that utilize existing school documentation and practices to the extent possible while maintaining compliance with CMS and NC Medicaid requirements. Identify and train any new requirements that must be met and establish reasonable rates to meet the requirements. Identify and train any new requirements that must be met and establish reasonable rates to meet the requirements. Utilize a team approach to address issues and utilize team when communicating with CMS Utilize a team approach to address issues and utilize team when communicating with CMS Identify other partners who need to be informed of or be a part of the planning and development of Medicaid services in schools. Identify other partners who need to be informed of or be a part of the planning and development of Medicaid services in schools.

Priorities Nursing Services Nursing Services OT and PT Services OT and PT Services Audiology Services Audiology Services Psychological Services Psychological Services Identification of other services that schools may provide or bill Identification of other services that schools may provide or bill Issues regarding services provided by others in schools Issues regarding services provided by others in schools

Nursing Services July 18 and September 21 meetings July 18 and September 21 meetings –Flexibility in options of service provider –Scope of services, documentation –Comparison of other nursing services by other providers –Next steps LEA as direct provider LEA as direct provider Other agencies as provider, place of service-schools Other agencies as provider, place of service-schools CCNC Networks CCNC Networks Financial Financial Legislative Legislative

Reminders Documentation Documentation –Medically necessity –Compliance to policy requirements FFS CPE Form FFS CPE Form –Form is required to be submitted for any quarter payment is received. –Revised FFS CPE form is on web.

ValueOptions and MH/DD/SA 6.6% ages 6-11with MH issues 6.6% ages 6-11with MH issues 7.8% ages with SA issues 7.8% ages with SA issues Delays Delays MH/SA/DD services in schools MH/SA/DD services in schools –693 day treatment, 23 pending Joint DMA/DMH memos Joint DMA/DMH memos Transition of MH/DD/SA in schools Transition of MH/DD/SA in schools –Video on DMH web

Other Medicaid Initiatives Pediatric Day Health Pediatric Day Health –Stakeholder Group –CAP-C Modifications EPSDT EPSDT CAP-MR/DD CAP-MR/DD Deficit Reduction Act (DRA) Deficit Reduction Act (DRA) –Case Management